Stop the Madness, #FixSGR Once and For All!

docToday, Morning Consult published a Guest Opinion piece featuring our own John A. Wilson, MD, a neurosurgeon from Winston-Salem, NC and chairman of the AANS/CNS Washington Committee. The article, “Stop the Madness, #FixSGR Once and For All!,” addresses the need for Congress to replace the flawed SGR payment formula to preserve seniors’ access to care.

As Dr. Wilson says in his op-ed,

“Year after year, because of Medicare’s flawed sustainable growth rate (SGR) formula, physicians face significant cuts in Medicare reimbursement. And time and time again, Congress intervenes with a short-term “fix” to prevent these steep cuts. In fact, Congress has employed 18 temporary fixes to override SGR pay cuts over the last 11 years. All these band-aid solutions inject continued uncertainty into our Medicare system and do nothing to ensure that our patients have timely access to medical care.

Let’s take a second to step back and understand how this madness started. The SGR was a provision of the Balanced Budget Act (BBA) of 1997. The SGR formula replaced something called the Medicare Volume Performance Standard (MVPS) and this formula, in part determines, how physicians are paid by Medicare. Under the SGR system, payments to physicians are updated annually based on whether or not physicians meet annual spending targets. To help rein in growth in Medicare expenditures, spending cannot exceed the rate of overall growth in the economy, as measured by the gross domestic product (GDP). If overall physician payments exceed target expenditures, then the SGR triggers an across-the-board reduction in payments to doctors. However, this only addresses a small part of the overall issue related to Medicare expenditure growth. Physician payments comprise a small and shrinking percentage of overall Medicare spending. Payments to doctors only account for approximately 12 percent of total Medicare expenditures — down from 14 percent in 2006. All other components of Medicare — e.g., hospitals, prescription drugs and nursing homes — are not subject to the SGR or similar expenditure targets.

Even though Congress has intervened with short-term legislative “patches” to avert the payment reduction, it’s important to note that these fixes have kept increases in physician payments well below inflation over time. Recent news reports would lead you to believe that doctors are “satisfied” with pay freezes, but that’s obviously not the case. Once inflation is factored in, all the patches really add up to cuts. To further compound the problem, the short-term fixes have also caused a huge difference between the actual level of Medicare spending and the target in the SGR formula.

The greatest concern related to the SGR is the challenge many seniors have getting timely access to care. Because physician payments have declined relative to inflation and the expense of running a medical practice, it is increasingly difficult for physician practices to remain financially viable. As a result, some practices have been forced to limit new Medicare patient referrals, or even stop participating in Medicare altogether. If impending cuts mandated by the SGR go through, it will be very difficult for many physicians to maintain their current level of participation in Medicare, further impeding patient access to care.

Last year, Congress, made significant progress toward a permanent repeal of Medicare’s SGR payment system. House and Senate leaders, representing three key congressional committees, spent countless hours to develop a compromise SGR reform bill. As it stands right now, the Congressional Budget Office (CBO) estimates that that the cost of the compromise SGR reform bill developed last year would be approximately $140 billion over 10 years. In contrast, the cumulative cost of the patches since 2003 is estimated at $169.5 billion. It’s time for the madness to stop! Given these numbers, it doesn’t take a genius to figure out that Congress has spent more on temporary patches than what it would cost to pay for a permanent SGR repeal bill.

Unless Congress acts, physicians face a 21 percent Medicare pay cut on April 1, 2015. America’s neurosurgeons, together with rest of the medical community, are urging Congress to continue the progress already made and once-and-for-all, replace the flawed SGR payment formula to preserve seniors’ access to care.”

Posted in Access to Care, Coding and Reimbursement, Congress, Cross Post, Health, Medicare, SGR | Tagged , , |

Faces of Neurosurgery – Saluting Dr. Babak S. Jahromi: Applying Neurosurgical Expertise to Save a Patient with Heart Disease

krisGuest post from Kristopher T. Kimmell
Neurosurgical Resident, University of Rochester Medical Center
Rochester, NY

Babak S. Jahromi, MD PhD, though a neurosurgeon, used his skill and expertise to save the life of a heart patient with a rare disorder. Since February is American Heart Month, it is fitting to honor him for his efforts.

001-_D3S5369Dr. Jahromi is Surgical Director of the University of Rochester Comprehensive Stroke Center. Through a serendipitous sequence of events, a young woman with a very rare arteriovenous malformation (a growing tangle of abnormally connected arteries and veins, also known as an “AVM”) of her heart came under his care. For this unfortunate patient, the AVM acted as an incurable mass that continued to grow, leaving her with heart transplantation as her only remaining option. However, by a remarkable twist of fate, hospital renovations temporarily brought Dr. Jahromi into the cardiac catheterization center to perform his cerebrovascular angiographic procedures. During this time, he encountered interventional cardiologists who were stymied in their efforts to develop a treatment plan for this woman’s condition. This led to collaboration with cardiologist Dr. Christopher Cove, and together they proceeded to attempt “embolization” of the AVM with a liquid glue-like substance called Onyx, a procedure that is commonly used to treat brain AVMs.

Onyx_AVM_2The result was a success. With its blood flow cut off, the AVM stopped growing and subsequently regressed in size, with the patient remaining well to date. The case is unique and represents a pioneering treatment for this life-threatening heart condition. This sparked further collaborations between Dr. Jahromi and his cardiology colleagues, bringing other avenues of collaboration using advanced minimally invasive neurosurgical techniques to help treat rare heart conditions.

Dr. Jahromi is a tireless clinician and patient advocate. His research efforts are devoted to advancing interventional treatments for stroke and brain aneurysm patients. He maximizes the benefits of technology to improve patient care, and helps push forward innovative treatments. For his efforts to advance patient care and for his specific impact on one special patient, we recognize him as one of the many Faces of Neurosurgery.

Want to know more? Click here, to access Dr. Jahromi’s research efforts. More information about this remarkable patient is available here.

Posted in Faces of Neurosurgery, Guest Post, Health, Medical Innovation | Tagged , , , , , , , , , , , |

Philip Glass and Healthcare Reform (Part 2)

Guest Post from Deborah L. Benzil, MD, FACS, FAANS
4Member, AANS Board of Directors
Chair, AANS/CNS Communications and Public Relations Committee
Columbia University Medical Center
Mt Kisco, New York
Daniel K. Resnick, MD
Past President, Congress of Neurological Surgeons
Professor, Vice Chairman and Program Director
Department of Neurosurgery University of Wisconsin
Madison, WI

glass 1Homily #2: “The Importance of Being “Collaboration”

Philip Glass, born in 1937 in Baltimore, is one of the most prolific and successful musicians of the 20th century. He has written for opera, musical theater, choirs, dance, chamber music, film, and symphony. He was recently honored as the Michael L.J. Apuzzo Lecturer during the Congress of Neurological Surgeons’ Annual Meeting 2014. As related in Homily #1: The Importance of Being “Tuned” Glass’ dialogue with CNS President Dr. Daniel Resnick and Dr. Arun P. Amar associated at least two critical homilies for the current morass known as healthcare reform. This was what he related about his own experience with collaboration, creativity and success.

Homily #2

glass 2During his career, he tried very hard to continually reinvent things by working with others. During such a collaborative process, he said he would meet someone he did not know. This would lead to the development of a problem that had not been solved before. One solution would be to dissolve the new collaboration and move on. However, Glass explained that he tried to allow his problem to bring the rediscovery of the crucial resources needed that allow one to move from a thing not known to a thing known. In this way, something new happens; there is inspiration from what someone else brings to the table. What has been the result? Einstein on the Beach, Koyaaniqatsi, Symphony No 9, Metamorphosis, Music in 12 Parts — to name just a few.

glass3Hum, inspiration, collaboration, creativity — what do these have to do with healthcare? Everything! As we have traveled the road of trying to address the many challenges the U.S. healthcare system faces today, those who have led (representing sectors such as hospitals, pharma, device makes, and insurance companies) and those who have set policy (elected on both sides of the aisle and employed in government) have failed at true collaboration. What others — including patients and physicians — bring to the table is seen as threatening. The resources that created this great system have been forgotten (physician morale is at historic lows and innovation in medicine has slowed tremendously) and the resources that can help us bridge from the past to the future are being constantly undermined. It is time to turn back — not to the old system — but to a time where we committed to collaboration and celebration of the value that diversity should bring to solving these critical problems. We must always remember:  in the end, doctors are the ones that provide the care patients need, while the rest of the system should support that most basic of all resources.

Posted in Medicare |